Over the past several years, there has been continued focus on reducing the number of individuals being readmitted to a hospital once they have been discharged to a skilled nursing facility. Food and nutrition can be a major player in whether a resident’s condition improves or declines after admission to a skilled nursing facility. Registered Dietitians (RD’s) are an integral part of the interdisciplinary team focusing on assessing residents as they are admitted and addressing and potential nutritional risks.
The Centers for Medicare and Medicaid Services (CMS) uses the rate of re-hospitalization of short term stay residents, following their admission to a nursing home, as a quality indicator for facility rating. In an effort to detour unnecessary hospitalizations, skilled nursing facilities (SNF) are subject to penalties of up to 2% of their Medicare reimbursement for higher-than-average rates of hospitalization readmissions. This follows the 2014 Protecting Access to Medicare Act which includes a measure for all-cause, all-condition readmission to any hospital from a SNF within 30 days following a hospital discharge.
Whether currently hospitalized or entering into a skilled nursing facility for rehabilitation and care, residents are faced with a multitude of stressors that can impact their overall nutritional status and dietary intakes, leaving them more susceptible to poor outcomes and potential for malnutrition. This in turn could leave residents at risk for rehospitalizations, impaired healing, poor nutritional status and increased risk for skin breakdown and falls. Studies have shown the average cost for patients who are readmitted to the hospital and have a diagnosis of malnutrition can be 26% higher per patient than those without.
RD’s are experts in identifying malnutrition and the risk for malnutrition. With the identification and implication of appropriate nutritional interventions, overall costs can be reduced along with improved patient outcomes. The risk for rehospitalization can be reduced by 28% when dietary interventions are implemented. Nutrition interventions to reduce rehospitalizations include:
- Screening for malnutrition and risk-for on every admission to SNF with a validated screening tool
- Completing assessments in timely fashion
- Focusing on the nutritional plan of care including dietary interventions that align with patient goals of care
- Monitoring weights and dietary intakes per facility protocols
- Utilizing oral nutritional supplements as appropriate and/or fortified foods to maximize oral intakes for nutritional support
- Honoring food preferences as able to encourage oral intakes
Identifying, treating, and decreasing resident risk for malnutrition through screening and coordination of resident care continues to be shown to reduce risk for hospital returns. RD’s remain leaders and advocates for early nutrition interventions, which are shown to not only improve outcomes and aid in reduced hospital readmissions but can also provide support to a facility’s bottom line.
1)How will SNF readmissions penalties affect hospitalists? (2017). Retrieved from https://www.the-hospitalist.org/hospitalist/article/154817/transitions-care/how-will-snf-readmissions-penalties-affect-hospitalists/page/0/1
2)ASPEN: New Data Show U.S. Hospital Readmissions are 54 Percent Higher for Malnourished Patients. (2017). Retrieved from https://www.nutritioncare.org/Press_Room/2017/New_Data_Show_U_S__Hospital_Readmissions_are_54_Percent__Higher_for_Malnourished_Patients/
3)Cowan-Lincoln, M. (2013, July). Nutritional Intervention Can Improve Hospital Patients’ Outcome, Reduce Costs. Retrieved from https://www.the-hospitalist.org/hospitalist/article/125737/nutritional-intervention-can-improve-hospital-patients-outcome-reduce
4)Riley, K., Sulo, S., Dabbous, F., Partridge, J., Kozmic, S., Landow, W., . . . Sriram, K. (2019). Reducing Hospitalizations and Costs: A Home Health Nutrition‐Focused Quality Improvement Program. Journal of Parenteral and Enteral Nutrition, 44(1), 58-68. doi:10.1002/jpen.1606